HomeMy WebLinkAboutOpening of Bids - Beacon Health New Parking Proj No 123-076A - Gibson-LewisCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Beacon Health Parking Lot, 530 N. Lafayette Blvd. South Bend, IN
Project No. 123-076A
For Bids Due 10 December 2024
PART I
(Must be completed for all bids. Please type or print)
Date: 12/10/24 Bidder (Firm): Gibson -Lewis, LLC
Address: 1001 W. I Ith Street
City/State/Zip: Mishawaka, IN 46544 Telephone Number: ( 574 ) 259-8581
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Beacon Health Parking Lot as described in the documents.
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
American Structurepoint, Inc.
and dated 11/13/2024
for the sum of (enter the Total Bid as shown on the Proposal)
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified
in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in
accordance with the notice. Any addendums attached will be spec' ally referenced at the applicable
page.
If additional units of material included in the contract ar neede , the cos of units must be the same as
that shown in the original contract if accepted by t e C y o� $ th n . the bid is to be awarded on a
unit basis, the itemization of the units shall be sh n o as rate c ment.
By
`� 5i nature)
ick G rbick, Vice P siI
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this day of 20
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
Joseph R. Molnar, Vice President
Briana N. Micov, Member
Version 07/19/2023 Contractor's Bid for Public Works - 2
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name:
Beacon Health Parking Lot
Project Number:
123-076A
For Bids Due:
10 December 2024
Contractor Name:
Gibson -Lewis, LLC
BASE BID
07 J s
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Beacon Health Parking Lot as
_
described in the documents.
1
LSUM
BASE BID TOTAL
UNIT PRICES
The unit costs herein quoted are to apply to additions or deductions to the
contract. The following Unit prices are for the cost of the material installed,
unless noted otherwise. The unit prices shall Include all incidental items,
such as use of tools, scaffolding, equipment, contractor's overhead and
Profit, taxes, insurance, etc.
All quantities will be determined by measurements in place.
The right is reserved to reject any and all unit prices if the cost is
considered excessive.
Item
DescriNo.ption
Price
Units
Removal of Unsuitable Materials (as determined by testing
1
agency); which includes cost of excavation, loading, hauling
$
Per
CYS
and offsite disposal
Removal of Suitable Materials (as determined by testing
2
agency); which includes cost of excavation, loading, hauling
$
Per
CYS
and offsite disposal
Removal and haul off of existing HMA pavement; including
3
subbase
$
Per
CYS
4
Removal and haul off of existing concrete sidewalk; including
$
Per
subbase
SF
5
Removal and haul off of existing concrete curb and gutter
$
Per
LF
6
Fuel Tank Removal and Disposal; includes concrete
$
Per
enclosure
EA
7
Concrete ADA Ramp
$
Per
EA
8
Concrete Curb and Gutter
$
Per
LF
9
Concrete Sidewalk (includes aggregate subbase)
$
Per
SF
Version 07/19/2023 Contractor's Bid for Public Works - 8
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: Beacon Health Parking Lot
Project Number: 123-076A
For Bids Due: 10 December 2024
Contractor Name: Gibson -Lewis, LLC
10
Concrete Pavement - Heavy Duty (includes aggregate
subbase)
$
Per
SF
11
Concrete Pavement - Heavy Duty Decorative Stamped
(includes aggregate subbase)
$
Per
TON
12
HMA Surface (9.5 mm)
$
Per
TON
13
HMA Intermediate Base (19.0 mm)
$
Per
TON
14
HMA Base (25.0 mm)
$
Per
TON
15
Compacted Aggregate, INDOT #53 Stone
$
Per
TON
16
Compacted Aggregate, INDOT #8 Stone
$
Per
TON
17
Compacted Aggregate, INDOT #2 Stone
$
Per
TON
Bidder (Firm):
Address:
Gibson -Lewis, LLC
1001 W. I Ith Street
City/State/Zip: Mishawaka, IN 46544
re)
Nick Gurbick, Vice President
(Printed Name of Person Signing)
Version 07/19/2023 Contractor's Bid for Public Works - 9
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF INDIANA )
) SS:
ST JOSEPH COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid
and without any agreement, understanding or combination with any other person in reference to such
bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive
directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any
agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5,
as amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Version 07/19/2023 Contractor's Bid for Public Works - 5
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently leams is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor
agrees to maintain this certification throughout the term of the contract with the City of South Bend, and
understands that the City may terminate the contract for default if the Contractor fails to cure a breach of
this provision no later than thirty (30) days after being notified by the City.
6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate against any
employee or applicant for employment in the performance of a City contract with respect to hire, tenure,
terms, conditions, or privileges of contract or employment, or any matter directly or indirectly related to
contracting or employment because of race, sex, religion, color, national origin, ancestry, gender
expression, gender identity, sexual orientation, or due to age or disability that does not affect that person's
ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions will consider the Contractor's good faith efforts to obtain participation by those
subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business
Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder.
Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE;
however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts,
Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the
Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A
finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a
City contract for a period of one (1) year from the date of such determination, and such determination may
also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be
made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any
of its agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in
the performance of this contract with privileges of employment, or any matter directly or indirectly related
to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 1
hereby certify that I and all subcontractors employed by me for this project will use steel products or
foundry products made in the United States on this project if awarded. I understand I have an affirmative
duty to notify the City in my bid that my proposal does not include the use of steel products or foundry
products made in the United States. I understand it is my sole obligation and responsibility to provide a
justification to the City, subject to review and approval, why the cost of United States made steel or
foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel
products or foundry products made in the United States, the City, through its director of public works, shall
make a determination if the price of United States made steel or foundry is unreasonable. I understand that
Version 07/19/2023 Contractor's Bid for Public Works - 6
violations hereunder may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 1 Oth
A ay of Deceml�Q020?^
Subscribed and sworn to before me this
My Commission Expires
08/05/2031
Nick Gurbick, Vice President
Printed Name and Title
of December 20 24
County of Residence St.
Public ]uli Hodowaniec
JLJL� H000wANiEC
St Josef CounPublic
- Sta Seal
Comn1fssion Number NpO6j1289a
MY Camn,fssion ExRfres Aug g, 2Q;1
Version 07/19/2023 Contractor's Bid for Public Works - 7
uluson-Lewis, LLL
The undersigned hereby declares that the foregoing is a true statement of the financial condition of the individual, co -partnership, or corporation herein first named, as of
the date herein first given; that this statement is for the express purpose of inducing the party to whom it is submitted to award the submitter a contract; and that any
depository, vendor or other agency herein named is hereby authorized to supply such party with any information necessary to verify this statement.
NOTE: A co -partnership must give firm name and signatures of all partners. A
corporation must give full corporate name, signature of official and affix corporate seal.
STATE OF
COUNTY OF
Affidavit for Individual
ISS:
being duly sworn, deposes and says that
the foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as of the date thereof and that the
answers to the foregoing interrogatories are true.
Subscribed and sworn to before me this
day of
Notary Public
Affidavit for Co -Partnership
STATE OF
COUNTY OF
SS:
(Applicant must sign here)
being duly sworn, deposes and says that
he is a member of the firm of . that he is familiar with the
books of the said firm showing its financial condition; that the foregoing financial statement, taken from the books of said firm, is a true and accurate
statement of the financial condition of the said firm as of the date thereof and that the answer to the foregoing interrogatories are true.
Subscribed and sworn to before me this
(Member of firm must sign here)
day of
Notary Public
Affidavit for Corporation
STATE of INDIANA
COUNTY OF ST. 30SEPH SS:
Nick Gurbock being duly sworn, deposes and says that he is
Vice President of the Gibson -Lewis LL DMM *
described in and which executed the foregoing statement; that he is familiar with the books of the sai orporatia sho in ' s financial condition; that
the foregoing financial statement, taken from the books of the said corporation, is a true and accurn at?Mn ❑f the s d ial condition of said
corporation as of the date thereof and that the answers to the foregoing interrogatories are true. mi d Lia Ity n
Subscribed and sworn to before me this
ffi x m t sign here)
1 Oth day of December ,0 24 Nick Gu Wck Vice r ident
J IBWANIEC
ry Public - Seal
Notary Public Juii I {v�i un County -State of Indiana
sston Number NP0671289
My Commission Expires: 8/05/2031 My Commission Expires Aug, 5, 2031
-14-
Residing in St. Joseph County
Document A310TM - 2010
Conforms with The American Institute of Architects AIA Document 310
CONTRACTOR:
(Name, legal status and address)
Gibson -Lewis, LLC
1001 West 11th Street
Mishawaka, IN 46544
OWNER:
(Name, legal status and address)
City of South Bend, Indiana
227 West Jefferson Blvd.
South Bend, IN 46601
Bond Number: 03992-CNA-24-175
SURETY:
(Name, legal status and principal place of business)
The Continental Insurance Company
151 N Franklin Street
Chicago, IL 60606
State of Inc: Pennsylvania
BOND AMOUNT: Five Percent of Amount Bid (5% of the Amount Bid)
PROJECT:
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
(Name, location or address, and Project number, if any)
Beacon Health Parking Lot - 530 N. Lafayette Blvd. South Bend, IN - Project #123-076A
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid,
and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the
jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for
the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference,
not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the
Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall
be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement
between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the
Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids
specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond
sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be
deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so
furnished, the intent is that this Bond shall be construed as a statutory bond and nit as a common law bond.
and sealed this 22nd day of
Juli Hodowaniec
November 2024
Ni
(Surety)
LLC
Vice President
Insurance Cornpan
lannotta _—
(Title) Kristin . Bender, Attorney -in -Fact
(Seal)
(Seal)
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That The Continental Insurance Company, a Pennsylvania insurance company, is a duly organized and existing insurance
company haling its principal office in the City of Chicago, and State of Illinois, and that it does by virtue of the signature and seal herein affixed hereby make, constitute
and appoint
Kristin S. Bender , Individually
of Morristown New Jersey : its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for
and on its behalf bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
Surety Bond Number: _ 03992-CNA-24-175
Principal; Gibson -Lewis, LLC
Obligee: City of South Bend Indiana
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the insurance company and all the acts of said
Attorney, pursuant to the authority hereby given is hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Laws and Resolutions, printed below, duly adopted, as indicated, by the Board of
Directors of the insurance company.
In Witness Whereof, The Continental Insurance Company has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on
this 13th day of March, 2024.
The Continental Insurance Company
c
Larry Kasten Vice President
State of South Dakota, County of Minnehaha, ss:
On this 13th day of March, 2024, before me personally came Larry Kasten to me known, who, being by me duly sworn, did depose and say: that he resides in the City
of Sioux Falls, State of South Dakota; that he is a Vice President of The Continental Insurance Company, a Pennsylvania insurance company, described in and which
executed the above instrument; that he knows the seal of said insurance company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said insurance company and that he signed his name thereto pursuant to like authority, and acknowledges same to be
the act and deed of said insurance company.
SS M.BENT I,
}�"gNOA{HY PUBLICS j
i� SOk11'H PUM
My Commission Expires March 2, 2026 M. Bent Notary Public
CERTIFICATE
I, Paula Kolsrud, Assistant Secretary of The Continental Insurance Company, a Pennsylvania insurance company, do hereby certify that the Power of Attorney herein
above set forth is still in force, and further certify that the By -Laws and Resolutions of the Board of Directors of the insurance company printed below are still in force. In
testimony whereof have hereunto subscribed my name and affixed the seal of the said insurance company this 22nd day of November 2024
:rCZ��hLtHBU,� .
The Continental Insurance Company
V) opj,�,nj
Paula Kolsrud �A3sistant Secretary
Authorizing By -Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF THE CONTINENTAL INSURANCE COMPANY:
This Power of Attorney is made and executed pursuant to and by authority ofthe following resolution duly adopted by the Board of Directors of the Company at a
meeting held on May 10, 1995.
"RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the
Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be
provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective."
This Power of Attorney is signed by Larry Kasten, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of The
Continental Insurance Company.
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company by
unanimous written consent dated the 251" day of April, 2012:
"Whereas, the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers (the "Authorized Officers") to execute various
policies, bonds, undertakings and other obligatory instruments of like nature; and
Whereas, from time to time, the signature of the Authorized Officers in addition to being provided in original, hard copy format, may be provided via facsimile or
otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be
valid and binding on the Company."
This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic -formatted corporate seal under and by the authority of the
following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 27th day of April, 2022:
"RESOLVED: That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and
confirm the use of a digital or otherwise electronic -formatted corporate seal, each to be considered the act and deed of the Company."
Form F6850-2/2024
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-1.0 '
MBE UTILIZATION PLAN
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is
the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications.
***Goals should be calculated based on the Base Bid only.***
Project Number:
Bidder:
123-076A Project Name: Beacon Health Parking Lot, 530 N. Lafavette Blvd. South Bend, IN
Gibson -Lewis, LLC Total Bid Amount:
MBE Goal: 2.6%
Page of
Name & Address of MBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of MBE
Component
Percentage
of Total
Bid/Proposal
Submitted by: Nick Gurbick, Vice President 12/10/24
Print Name ignat re Date
***Goals should be calculated based on the Base Bid only.***
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It
Version 07/19/2023 Contractor's Bid for Public Works -10
CITY OF SOUTH BEND -_ J
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN =
FORM WBE-1.0
WBE UTILIZATION PLAN
is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications.
***Goals should be calculated based on the Base Bid only.***
Project Number:
Bidder:
123-076A
Project Name: Beacon Health Parking Lot, 530 N. Lafayette Blvd. South Bend, IN
Gibson -Lewis, LLC Total Bid Amount:
WBE Goal: 5.1 %
Page of
Name & Address of WBE
Primary Contact Person
(Name/Telephone)
Scope of Work to be Performed
(Attach scope/schedule if you need additional space)
Dollar Amount of WBE
Component
Percentage
of Total
Bid/Proposal
All Lh
Submitted by: Nick Gurbick, Vice President
Print Name gignat re
***Goals should be calculated based on the Base Bid only.***
Version 07/19/2023 Contractor's Bid for Public Works - 11
12/10/24
Date
..}filf y�.
Y
CITY OF SOUTH BEND i
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0 n,
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE participation.
Project Number: 123-076A Date:
Project Name:
Bidder:
Contact Person:
Address:
Beacon Health Parking Lot,_ 530 N. Lafayette Blvd. South Bend, IN
Gibson -Lewis, LLC
Nick Gurbick, Vice President Telephone: 574-259-8581
1001 W. 11 th Street
City: Mishawaka State: IN zip: 46544
Email: ngurbick(�gl.nceusa.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goals set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business
Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the
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Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and
non -certified) found at: htt :/Iwww.in. ov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE
participation in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business
Enterprise Inclusion Program Plan and the Indiana Department of Administration's
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certified list of Indiana Minority and Women Business Enterprises, found on their website
(htip://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
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performed by MWBEs, including, where appropriate, breaking out contract work items
into economically feasible units to facilitate MBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
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means the interest of all MBEs in the scopes of work of the contract.
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I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to
inform MBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
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concerning subcontract opportunities and allowed MBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a
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manner reasonably calculated to inform MBEs of subcontracting opportunities and
allowed sufficient time for MBEs to participate effectively.
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I affirm that I followed up on initial solicitations with interested MBEs.
I affirm that I negotiated with interested MBEs in good faith, including providing such
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MBEs with adequate information about the plans, specifications and other requirements
of the subcontract.
I affirm that I have made good faith efforts to assist interested MBEs in obtaining
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bonding, lines of credit, or insurance as required by the City or the bidder, where
appropriate.
Version 07/19/2023 Contractor's Bid for Public Works - 12
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested MBEs in obtaining
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necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
NCi
I affirm that I did not reject any MBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid
on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBE was unqualified to perform the job.
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 07/19/2023 Contractor's Bid for Public Works - 13
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANY'-,
FORM MBE-2.1
MBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed
minority -owned business meets the MBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Numb 123 QA MBE Participation Goal 2.6%
Project Na e: f eaco alth Parking Lot, 530 N. Lafayette Blvd. South Bend IN
Bidder: Gi n- ewis, LL
By: Vice President 12/10/24
ignat re) ick Gi bick (Title) (Date)
MBE Firm
Owner or Contact at MBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
MBE Firm
Owner or Contact at MBE Firm
Telephone Fax: Email
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 16
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLANY'-,
FORM MBE-2.1
MBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed
minority -owned business meets the MBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Numb 123 QA MBE Participation Goal 2.6%
Project Na e: f eaco alth Parking Lot, 530 N. Lafayette Blvd. South Bend IN
Bidder: Gi n- ewis, LL
By: Vice President 12/10/24
ignat re) ick Gi bick (Title) (Date)
MBE Firm
Owner or Contact at MBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
MBE Firm
Owner or Contact at MBE Firm
Telephone Fax: Email
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 16
CITY OF SOUTH BEND n
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any
listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 123-07fiA d WBE Participation Goal 5.1 %
Project NaB can H th Parkin Lot 530 N. Lafayette Blvd. South Bend, IN
7//"hbs
Bidder: - wis. LLC
By: Vice President 12/10/24
( gnatu a {;'rk (Title) (Date)
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 17
CITY OF SOUTH BEND n
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any
listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 123-07fiA d WBE Participation Goal 5.1 %
Project NaB can H th Parkin Lot 530 N. Lafayette Blvd. South Bend, IN
7//"hbs
Bidder: - wis. LLC
By: Vice President 12/10/24
( gnatu a {;'rk (Title) (Date)
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 17
CITY OF SOUTH BEND n
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any
listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 123-07fiA d WBE Participation Goal 5.1 %
Project NaB can H th Parkin Lot 530 N. Lafayette Blvd. South Bend, IN
7//"hbs
Bidder: - wis. LLC
By: Vice President 12/10/24
( gnatu a {;'rk (Title) (Date)
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 17
CITY OF SOUTH BEND n
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any
listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary.
PAGE OF
Project Number: 123-07fiA d WBE Participation Goal 5.1 %
Project NaB can H th Parkin Lot 530 N. Lafayette Blvd. South Bend, IN
7//"hbs
Bidder: - wis. LLC
By: Vice President 12/10/24
( gnatu a {;'rk (Title) (Date)
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
WBE Firm
Owner or Contact at WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE WBE FIRM:
Version 07/19/2023 Contractor's Bid for Public Works - 17
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MWBE participation.
Project Number: 123-076A Date: 12/10/24
Project Name: Beacon Health Parking Lot, 530 N. Lafayette Blvd. South Bend, IN
Bidder: Gibson -Lewis, LLC
Contact Person: Nick Gurbick, Vice President Telephone: 574-259-8581
Address: 1001 W. 1 Ith Street
City: Mishawaka State: Indiana Zip: 46544
Email: n urbick[rr�,g1mccusa.com
To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below":
EVIDENCE OF GOOD FAITH EFFORTS
WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business
Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the
NG
Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and
non -certified) found at: http://www.in.qov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE
participation in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business
Enterprise Inclusion Program Plan and the Indiana Department of Administration's
NG
certified list of Indiana Minority and Women Business Enterprises, found on their website
(http://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
NG
performed by WBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate WBE participation.
I affirm that I have made good faith efforts to solicit through all reasonable and available
NG
means the interest of all WBEs in the scopes of work of the contract.
NG
I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to
inform WBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
NG
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a
NG
manner reasonably calculated to inform WBEs of subcontracting opportunities and
allowed sufficient time for WBEs to participate effectively.
NG
I affirm that I followed up on initial solicitations with interested WBEs-
I affirm that I negotiated with interested WBEs in good faith, including providing such
NG
WBEs with adequate information about the plans, specifications and other requirements
of the subcontract.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
NG
bonding, lines of credit, or insurance as required by the City or the bidder, where
appropriate.
Version 07/19/2023 Contractor's Bid for Public Works - 14
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
i affirm that I have made good faith efforts to assist interested WBEs in obtaining
NG
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
N�
I affirm that I did not reject any WBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid
on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MWBE was unqualified to perform the job.
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 07/19/2023 Contractor's Bid for Public Works - 15
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms
outside your own firm who have performed part of the work) that you have used on public
works projects during the past five (5) years along with a brief description of the work done
by each subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project,
you are under a continuing obligation to immediately notify the City of South Bend in the
event that you subsequently determine that you will use a subcontractor on the proposed
project.
4. Attach a listing of equipment you have available to use for the proposed project.
Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
*See attached Financial Statement
Version 07/19/2023 Contractor's Bid for Public Works - 3
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the
bidder's capability for completing the project if awarded.
Version 07/19/2023 Contractor's Bid for Public Works - 4
131dder: Uibson-Lewis, LLU
3. Have you ever failed to complete any work awarded to you? No
If so, where and why?
4. List references from private firms for which you have performed work.
University of Notre Dame - Notre Dame, Indiana
Memorial Hospital of South Bend - South Bend, Indiana
1st Source Bank - South Bend, Indiana
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
Apply adequate personnel to complete the work
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work) that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
Please see attached listing
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Beacon Health Parking Lot, 530 N. Lafayette Blvd. South Bend, IN
Project No. 123-076A
For Bids Due 10 December 2024
From time to time the South Bend Board of Public Works finds it necessary to reject a bid
because it does not comply with statutory requirements. In preparing your bid, please use the
following checklist in order to make sure that your bid is done in the proper manner.
X Proper bid security included. The bidder has the option of providing either a Certified Check
or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good
Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and
X WBE-2.1].
X Acknowledge Receipt of Addendum(s) included with the bid.
X All required additional information is included with the bid.
X Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need t"ead arpdT9mply))0ith the specifications.
Bidder: Gibson -Lewis, LW/ / 1 // Date: 12/10/24
By Authorized Represe
Signature:
Print Name & Title: Nick Gurbick, Vice Nesident
Version 07/19/2023 Contractor's Bid for Public Works - 1
1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1 830
PHONE 574/235-9251
FAX 574/235-9171
TDD 574/ 235-5567
CITY OF SOUTH BEND, .TAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
Date: December 6, 2024
To: All Planholders
From Theresa Heffner, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name: Beacon Health Parking Lot
Project Number: 123-076A
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 12/6/24
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by including with your electronic bid submission.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein. i
Company: Gibson
Authorized Signature:
ick Gu3 fck�ce
Date: 12/6/24
Version 8/1 1/2020
KMFI-ijL,,
SELECTED SUBS FOR FORM 96
INDIANA EARTH
EXCAVATING
RITSCHARD BROS., INC.
10343 MCKINLEY HWY.
1204 W SAMPLE STREET
OSCEOLA, IN 46561
SOUTH BEND, IN 46619
WALSH & KELLY
PAVING
RIETH RILEY CONSTRUCTION
24358 STATE ROAD 23
25200 STATE ROAD 23
SOUTH BEND, IN 46614
SOUTH BEND, IN 46614
ZIOLKOWSKI CONSTRUCTION
MASONRY
KWIATKOWSKI MASONRY
1005 S LAFAYETTE STREET
1006 N INDIANA AVENUE
SOUTH BEND, IN 46601
CROWN POINT, IN 46307
STEVENS IRON WORKS, INC
STRUCTURAL STEEL
CRANE INDUSTRIAL SERVICES
P.O. BOX 730
11035 ANDERSON ROAD
DEMOTTE, IN 46310
GRANGER, IN 46530
MIDLAND ENGINEERING
ROOFING
DUDECK ROOFING & SHEET METAL
52369 STATE HWY 933
1634 SOUTH FRANKLIN STREET
SOUTH BEND, IN 46637
SOUTH BEND, IN 46614
WERNTZ SUPPLY
GLASS & GLAZING
PRECISION WALL
1002 KERR STREET
3801 S MAIN STREET
SOUTH BEND, IN 46601
SOUTH BEND, IN 46614
OVERHEAD DOOR COMPANY
OVERHEAD DOOR
INDUSTRIAL DOOR OF NORTHERN IN
P.O. BOX 907
3839 S. MAIN STREET
MISHAWAKA, IN 46546
SOUTH BEND, IN 46614
MIDWEST TILE & INTERIORS INC
FLOORING
INTERIOR FINISHES, INC.
1805 N CEDAR ST
1616 W THIRD STREET
MISHAWAKA, IN 46545
OSCEOLA, IN 46561
SHAMBAUGH & SON
FIRE PROTECTION
RYAN FIRE PROTECTION
7614 OPPORTUNITY DR
9740 EAST 148TH STREET
FORT WAYNE, IN 46825
NOBLESVILLE, IN 46060
DA DODD, INC
PLUMBING & HVAC
EDWARD J WHITE
P.O. BOX 430
1011 S. MICHIGAN STREET
ROLLING PRAIRIE, IN 46371
SOUTH BEND, IN 46601
MARTELL ELECTRIC
ELECTRIC
KOONTZ WAGNER SERVICES
4601 CLEVELAND ROAD
3801 VOORDE DR SUITE B
SOUTH BEND, IN 46628
SOUTH BEND, IN 46628
Bidder: Gibson -Lewis, LLC
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
Unresolved
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
All necessary
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
No
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
*See attached Financial Statement
Timestamp-Beacon Lot
Company
Name
Dec 4, 2024 at 2:38 PM EST
Ritschard Bros., Inc.
Don Ritschard
Dec 4, 2024 at 3:17 PM EST
D&M Excavating Inc.
Dec 4, 2024 at3:17 PM EST
D&M Excavating Inc.
Ryan Miller
Dec 4, 2024 at 3:18 PM EST
Michiana Concrete & Excavation LLC
Devin Rudloff
Dec 4, 2024 at 3:19 PM EST
AlphaJak LLC
Andre Jackson
Dec 4, 2024 at 3:19 PM EST
Fox Contractors Corp.
Dallas D.
Dec 4, 2024 at 3:19 PM EST
Fox Contractors Corp.
Nik Knobtauch
Dec 4, 2024 at 3:20 PM EST
Hubinger Landscaping Corporation
david hubinger
Dec 4, 2024 at 3:20 PM EST
Hubinger Landscaping Corporation
Lorraine Keilman
Dec 4, 2024 at 3:20 PM EST
Modern Edge
joe drwaI
Dec 4, 2024 at 3:20 PM EST
Modern Edge
Drew Sarkisian
Dec 4, 2024 at 3:20 PM EST
Tobin Landscape, Inc.
Dan Tobin
Dec 4, 2024 at 3:20 PM EST
Tobin Landscape, Inc.
Sherry Barrick
Dec 4, 2024 at 3:20 PM EST
Michiana Concrete & Excavation LLC
Devin Rudloff
Dec 4, 2024 at 3:21 PM EST
The Great American Landscape
Leonard Rompca
Dec 5, 2024 at 4:10 PM EST
Doug & Steve Construction Inc.
Steve Sammons
Dec 5, 2024 at 4:10 PM EST
Doug & Steve Construction Inc.
Debbie Trevino
Dec 5, 2024 at 4:10 PM EST
Circle City Rebar, LLC
Michael Moyer
Dec 5, 2024 at 4:10 PM EST
Circle City Rebar, LLC
Bryce Williams
Email
Phone
Enterprise Type
Bid Package
ritl204@datacruz.com
+1574.2BB-4777
Women Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE)
Earthwork
chelsea@dandmexcavating.com
+1219-872-9378
Women Business Enterprise (WBE)
Earthwork
ryan@dandmexcavating.com
+1219-874-2882
Women Business Enterprise (WBE)
Earthwork
devin@michianamowsnow.com
+1574-370-8088
Small Business Enterprise (SBE), Women Business Enterprise (WBE)
Earthwork
ajackson@alphajak.com
+1574-800-4810 a Minority Business Enterprise (MBE), Disadvantaged Business Enterprise (DBE)
Asphalt
dday@foxcontractors.com
(260) 747.7461
Minority Business Enterprise (MBE)
Asphalt
nknoblauch@foxcontractors.com
+1260-755-7914
Minority Business Enterprise (MBE)
Asphalt
david@hubingers.com
+1219-662-9911
Women Business Enterprise (WBE)
Landscape
Lorraine@hubingers.com
+1219-662-9911
Women Business Enterprise (WBE)
Landscape
joedrwal@hotmail.com
+1219-869-5782
Women Business Enterprise (WBE)
Landscape
dsarkisian@modernedgellc.com
+1866-504-3343
Women Business Enterprise (WBE)
Landscape
dtobin@tobinlandscape.com
+1269-262-0257
Minority Business Enterprise (MBE)
Landscape
sbarrick@tobinlandscape.com
+1269-262-0257
Minority Business Enterprise (MBE)
Landscape
devin@michianamowsnow.com
+1574-370-8088
Small Business Enterprise (SBE), Women Business Enterprise (WBE)
Landscape
thegreatamericanlandscape@msn.com +1219-322-7033
Women Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE)
Landscape
ssammons@dands-const.com
+1219-322-9112
Women Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE)
Concrete
dtrevino@dands-const.com
+1219-322-9112
Women Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE)
Concrete
mmoyer@circlecityrebar.com
+1317-727-7279
Minority Business Enterprise (MBE), Small Business Enterprise (SBE), Disadvantaged Business Enterprise Concrete
bwilliams@circlecityrebar.com
+1317-917-8566
Minority Business Enterprise (MBE), Small Business Enterprise (SBE), Disadvantaged Business
Enterprise Concrete
Communicath Bidding Status
Bid Invite
BIDDING
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
BIDDING
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
UNDECIDED
Bid Invite
NOT -BIDDING
Bid Invite
NOT -BIDDING
EQUAL EMPLOYMENT OPPORTUNITY POLICY
GIBSON-LEWIS, LLC has adopted the following policy on equal employment opportunity:
The Company will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, age, national origin, disability, citizenship status,
genetic information, ancestry, off -duty tobacco use, sealed or expunged arrest or conviction
record and veteran status or any other basis protected by state, federal or other applicable
law. The company is also committed not to discriminate regarding the following:
■ Referral, Hiring, Placement, Upgrading, Promotion, Transfer, Demotion, or Award of
Tenure:
• Recruitment, Advertising, Solicitation for Employment, or Job Application Procedures;
• Rates of Pay or other Forms of Compensation and Changes in Compensation;
• Treatment during Employment;
• Job Assignments, Job Classifications, Organizational Structures, Position
Descriptions, Lines of Progression, and Seniority Lists;
• Leaves of Absence, Sick Leave, or any other Leave;
• Fringe Benefits Available by Virtue of Employment, Whether or Not Administered by
the Company;
• Activities Sponsored by the Company including Social or Recreational Programs;
• Selection and Financial Support for Training including Apprenticeship, Professional
Meetings, Conferences, and other Related Activities and Selection for Leave of
Absence to Pursue Training;
Layoff or Termination; Right to Return from Layoff, Rehire, and all other Terms and
Conditions of Employment
The Company further agrees to provide a reasonable accommodation to any otherwise
qualified individual with a disability unless the accommodation would cause an undue
hardship, as and to the extent required by the Americans with Disabilities Act.
The Company also seeks and intends to achieve and maintain full compliance with all other
applicable statutes, regulations and executive orders on equal employment opportunity.
THE COMPANY EXPECTS ALL EMPLOYEES TO ABIDE BY THIS POLICY.
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Beacon Health Parking Lot
Project No. 123-076A
For Bids Due Tuesday, December 10, 2024 @ 9:00 A.M. (E.S.T.)
Contractor Name: Gibson -Lewis, LLC
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
**THIS FORM ONLY APPLIES TO BIDS GREATER THAN $250,000. **
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
71 of The Responsible Bidding Ordinance No. 10975-23 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") within twelve (12) months of obtaining pre -qualified standing. If the status of any item changes
within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -
qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the
time prescribed above shall result in automatic removal of the designation, effective immediately following
the twelve (12) months of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-71 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-71 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 5/20/2024 General Conditions - 11
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-72 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least two -hundred fifty
thousand dollars ($250,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder for projects greater than $250,000 and all subcontractors performing work
greater than $250,000 on a public works project are required to submit certified payroll utilizing the
federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days
after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft
for each employee. Certified payrolls shall be submitted electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor.
Version 5/20/2024 General Conditions - 12
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(iii) X By checking this box, I hereby acknowledge that apprenticeship and training
programs that I participate in have graduated at least five (5) apprentices in each
of the past five (5) years.
(iv) X By checking this box, I hereby acknowledge that all subcontractors performing
work greater than $250,000 also meet the qualifications of the Responsible Bidder
Ordinance.
(b) Attachments:
(i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) X Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
(iii) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
(iv) X For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization. This includes, but may not be limited
to, letters from apprenticeship coordinators detailing the bidder's association with
the program, and the United States Department of Labor Office of Apprenticeship
Certificates of Registration of Apprenticeship Programs for each type of work to be
performed on the project.
(ii) Gibson -Lewis, LLC will provide qualified leadership and tradesman from a pool of experienced employees to meet
the requirements of the project. Long standing relationship with various craftsman unions including carpenters,
Iaborers, cement masons, plasterers, and painters.
Version 5/20/2024 General Conditions - 13
PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) _ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(v) _ By checking this box, I hereby acknowledge that apprenticeship and training
programs that I participate in have graduated at least five (5) apprentices in each
of the past five (5) years.
(vi) _ By checking this box, I hereby acknowledge that all subcontractors performing
work greater than $250,000 also meet the qualifications of the Responsible Bidder
Ordinance.
(b) Attachments:
(i) _
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
List identifying all former business names.
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv)
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v)
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(v)
For every project, submit evidence of participation in apprenticeship and training
programs, applicable to the work to be performed on the project, which are
approved by and registered with the United States Department of Labor's Office of
Apprenticeship, or its successor organization. This includes, but may not be limited
to, letters from apprenticeship coordinators detailing the bidder's association with
Version 5/20/2024 General Conditions - 14
the program, and the United States Department of Labor Office of Apprenticeship
Certificates of Registration of Apprenticeship Programs for each type of work to be
performed on the project.
(vi) _ _ Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(vii) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
(viii) Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(ix) List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
Nick Gurbick, Vice President
(Print Name Here)
Gibson -Lewis, LLC
(Name of Company)
1001 W. 1 Ith Street
(Address of Company)
Mishawaka
(City)
Indiana
(State)
574-259-8581
(Telephone Number)
Version 5/20/2024 General Conditions - 15
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
DEPARTMENT OF PUBLIC WORKS
ERIC HORVATH, DIRECTOR
September 11, 2024
Juli Hodowaniec
Gibson Lewis, LLC
JHodowaniec@gl.nceusa.com
RE: Pre -Qualification Verification
Dear Ms. Hodowaniec:
This letter serves as verification of Pre -Qualification status of your company for bidding
with the City of South Bend. This Pre -Qualification status is effective for twelve (12)
months from the date of this letter. Thereafter you are required to re -submit a complete
application for continuation of pre -qualification status within twelve (12) months from the
date of this letter.
A copy of this Verification Letter must be included with every bid exceeding $250,000
submitted to the City of South Bend Board of Public Works, along with your Pre -Qualified
Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Tara Bussell, Permit Manager
BUSINESS INFORMATION
DIEGO MORALES
INDIANA SECRETARY OF STATE
10/21/2024 03:24 PM
Business Details
Business Name: GIBSON-LEWIS, LLC Business ID: 1995051381
Entity Type: Domestic Limited Liability Company
Creation Date: 05/24/1995
Principal Office Address: 1001 USA W. 11th, MISHAWAKA, IN, 46544,
Jurisdiction of Formation: Indiana
100slered Agent Information
Type: Business
Business Status: Active
Inactive Date:
Expiration Date: Perpetual
Business Entity Report Due 05/31/2025
Date:
Years Due:
Name: NATIONAL CONSTRUCTION ENTERPRISES INC.
Address: 1001 W.11th, Mishawaka, IN, 46544 - 0000, USA
AIA Document A305
Contractor's Qualification Statement
1986 EDITION
This form is approved and recommended by the American Institute of Architects
(AIA) and The Associated General Contractors of America (AGC) for use in
evaluating the qualifications of contractors. No endorsement of the submitting
party or verification of the information is made by the AIA or AGC.
The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so
as not to be misleading.
SUBMITTED To: City of South Bend, IN
Board of Public Works
ADDRESS: 227 Jefferson Blvd
South Bend, IN
SUBMITTED BY:
NAME: Gibson -Lewis, LLC
ADDRESS: 1001 W. 11th Street
Mishawaka, IN 46544
PRINCIPAL OFFICE:
NAME OF PROJECT: Beacon Health Parking Lot
TYPE OF WORK:
X General Construction
Plumbing
Other
(Please specify)
Corporation
13
Partnership
El
Individual
Il
Joint Venture
Other
El
Limited Liability Company
HVAC
Electrical
Cv ri t 1964, 1969, 01986 b The American Institute of Architects, 1735 Now York Avenue, N.W. %shin mi,
epr uction n t tc matcria ierein or su antial quotation of is provisions w 1 out written pernusston o
the AIA violates the copyright laws of the United States and will be subject to legal prosecution.
AIA DOCUMENT A305 - CONTRACTOR'S QUALIFICATION STATEMENT • 1986 EDITION • AIAV - 01986
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON. D.C. 20006 A305-1986 1
k31U5U11-LUW15, LLU
1. ORGANIZATION
1.1 How many years has your organization been in business as a Contractor?
56 years
1.2 How many years has your organization been in business under its present business name?
28 years
1.2.1 Under what other former names has your organization operated?
Gibson -Lewis, Inc. was incorporated into LLC in 1995
1.3 If your organization is a corporation, answer the following:
1.3. l
Date of incorporation:
1.3.2
State of incorporation:
1.3.3
President's name:
1.3.4
Vice-president's name:
1.3.5 Secretary's name:
1.3.6 Treasurer's name:
1.4 If your organization is a partnership, answer the following:
1.4.1 Date of organization:
1 A.2 Type of partnership:
1.4.3 Name(s) of general partner(s):
1.5 If your organization is individually owned, answer the following:
1.5.1 Date of organization:
1.52 Name of owner:
AIA DOCUMENT A305 • CONTRACTOR'S QUALIFICATION STATEMENT • 1986 FOITION - AIAO -01986 A3�5.1988 2
THE AMERICAN 1NSTITU'rE OF ARCHrrECTS, 1735 Nr.W YORK AVENUE, N.W. WA UNGTON, D.C.2000G
Gibson -Lewis, LLC
1.6 If the fornt of your organization is other than those listed above, describe it and name the principals;
Robert A. Lingenfelter
James E. Nagle
Nicholas A. Gurbick
Elizabeth Biddle
2. UGENSING
- President
- Vice President
- Vice President
- Assistant Secretary
2.1 List jurisdictions and trade categories In which your organization is legally qualified to do business,
and indicate registration or Iloense numbers, if applicable:
Indiana and Michigan
2.2 List jurisdictions in which your organization's partnership or trade name is riled.
3. EXPERIENCE
3.1 List the categories of work that your organization normally porforms with its own forces.
Metal Framing, Drywall, Drywall Finishing, Insulation, Plastering, Acoustical Ceilings,
Firestopping, Concrete, Carpentry, Painting, and Selective Demolition
3,2 Clainis and Suits. (i r itte-answer to any of the questions below is ycs, please uUach details.)
3.2.) Has your organization ever failed to complete any work awarded to it?
No
3.2.2 Are there any judgments, elaints, arbitration proceedings or suits pending or outstanding
against your organization or It's officers?
No
3.2.3 Has your organization filed any law suits or requested arbitration with regard to
ens rue Ion conintc s t n file I qsi"live you sI
No
AIA DOCUMENT A305 -CONTRACT)OR'SQUALIFICATION 91WITMENT • 198611DIIION •A[A0 •01986
TIIK AM11RICAN 1NS'TITUTE Or ARCHITECTS, 1735 NLW YORK AVr..NUK, N.W. WASIIINGTON,D.C, 20006 A305.1986 3
Gibson -Lewis, LLC
3.3 Within the last five years, has any officer or principal of your organization ever been an officer or
Principal of another organization when it failed to complete a construction contract? (If the
answer is yes, please attach details.)
No
3,4 On a separate sheet, list major construction projects your organization has in progress, giving the
name of project, owner, architect, contract amount, percent complete and scheduled completion date.
Please see attached
3A.1 State total worth of work in progress and under contract:
3.5 On a separate sheet, list the major projects your organization has completed in the past five years,
giving the name of project, owner, architect, contract amount, date of completion and percentage of the
cost of work performed with your own forces. Please see attached
3.5.1 State average annual amount of construction work performed in the past five years:
3.6 List the construction experience and present commitments of the key
individuals of your organization.
Please see attached
4. REFERENCES
4.1 Trade References:
Foundation Building Materials
5203 Division Avenue
Grand Rapids, MI 49548
L & W Supply
1401 S Main Street
South Bend, IN 46613
Big C Lumber Company
50860 Princess Way
Granger, IN 46530
4.2 Bank References:
Wheaton Bank & Trust
211 South Wheaton Avenue
Wheaton, IL 60187
Office: 630-456-7853
Fax: 630-690-7715
4.3 Surety:
Phone: 616-534-4904
Fax: 616-724-2651
Phone: 574-289-5566
Fax: 574-289-5569
Phone: 574-277-4670
Fax: 574-271-3834
AIA DOCUMENT A305 - CONTRACTOR'S QUALIFICATION STATEMENT - 1986 EDITION - AIAO - V1986
TI IL' AMERICAN INSTITUTE OF ARC111TECI S, 1735 NEW YORK AVENUE, N.W. WASI IINO'rON, D.C. 20006 A305-1986 4
ubson-Lewis, LLC;
4.3.1 Name of bonding company:
The Continental Insurance Company
CNA Plaza - Chicago, IL 60603
4.3.2 Name and address of agent:
Marsh USA, Inc. Daniel Machado
One Towne Square, STE 1100
Southfield, MI 48076
5. FINANCING
5.1 Financial Statement,
5.1.1 Attach a financial statement, preferably audited, including your organization's latest balance
sheet and income statement showing the following items:
Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials, inventory and prepaid expenses);
Please see attached
Net Fixed Assets;
Other Assets;
Current Liabilities (e.g., accounts payable, notes payable, accrued expenses,
provision for income taxes, advances, accrued salaries and accrued payroll taxes);
Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par
values, earned surplus and retained earnings).
5.1.2 Name and address of firm preparing attached financial statement, and date thereof:
Crowe LLP - 330 E. Jefferson Blvd, South Bend, IN 46601
5.1.3 Is the attached financial statement for the identical organization named on page one?
Yes
5.1.4 If not, explain the relationship and financial responsibility of the organization whose financial
statement is provided (e.g., parent -subsidiary).
5.2 Will the organization whose financial statement is attached act as guarantor of the contract for
Construction ?
yes
AIA DOCUMENT A305 - CONTRACTOR'S QUALIFICATION STATEMENT - 1986 EDITION - AIA® - 01986
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON, D.C. 20006 A305-1986 5
Officer
Robert A. Lingenfelter
James E. Nagle
Nicholas A. Gurbick
Elizabeth Biddle
KEY PERSONNEL
# of Years
Title Experience
President 34 Years
Vice President 38 Years
Vice President 11 Years
Assistant Secretary 23 Years
Gibson -Lewis, LLC
6. SIGNATURE
6.1 Dated at Mishawaka, IN this
Name of 019;,jizKjg1- Gi�§h-Lewis, LLC
By:
Title:' Nick Gurick, Vine President
6.2
1 Oth
day of December, 202z
Nick Gurbick being
duly sworn deposes and says that the information provided herein is true and sufficiently complete as not to
be misleading.
Ifd and sworn he ' re me this 1 Oth day of December, 2024
Ju ' Hod. aniec
My Commission UN )fires: 8/05/2031 JULI HODOWANIEC
Notary Public - 5eal 5t Joseph CaUntY State nI fndiana
Commission NU+nber NPD6yp284
MY Commission Fxpfres Aug 5, 203 t
AIA DOCUMENT A305 - CONTRAc'rOR,s QUALIFICATION STATEMENT - 1986 EDITION - AIAV - 01986 A305.1986 6
THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVENUE, N.W. WARIINGTON, D.C.20W6
INDIANA/KENTUCKY/OHIO REGIONAL COUNCIL OF CARPENTERS
JOINT APPRENTICESHIP AND TRAINING FUND
1565 EAST 70TH COURT
MERRILLVILLE, IN 46410
ADMINISTRATIVE OFFICE
711 Greenwood Springs Drive
Greenwood, IN 46143
Phone:317-807-1112
Fax:317-807-1115
GRAYSON CAMPUS
574 Carpenters Way
Grayson, KY 41143
Phone:606-929-1362
Fax:606-929-5319
INDIANAPOLIS CAMPUS
711 Greenwood Springs Drive
Greenwood, IN 46143
Phone:317-807-1116
Fax:317-807-1131
LAFAYETTE CAMPUS
2953 South Creasy Lane
Lafayette, IN 47905
Phone:765-447-5959
Fax:765-447-7676
LOUISVILLE CAMPUS
1245 Durrett Lane
Louisville, KY 40213
Phone: 502-366-8668
Fax:502-366-8678
MERRILLVILLE CAMPUS
1565 East 701h Court
Merrillville, IN 46410
Phone:219-947-3348
Fax:219-947-1889
MUNCIE CAMPUS
5400 East Centennial Avenue
Muncie, IN 47303
Phone:765-288-9015
Fax:765-288-9298
NEWBURGH CAMPUS
5400 Covert Court
Newburgh, IN 47630
Phone:812-853-9312
Fax:812-853-9316
TERRE HAUTE CAMPUS
3099 S. Ch Street
Terre Haute, IN 47805
Phone:812-466-7899
Fax:812-466-9840
WARSAW CAMPUS
1095 Mariners Drive
Warsaw, IN 46582
Phone: 574-267-5264
Fax: 574-269-1464
November 29, 2024
Gibson Lewis, LLC
1001 W. I It" Street
Mishawaka, IN 46544
To Whom It May Concern:
Ne,
u
This letter is in response to verification needed by Gibson Lewis, LLC for work to be
performed on the Beacon Health Parking Lot, owner City of South Bend, Indiana
Board of Public Works. Gibson Lewis, LLC regularly employs a number of
apprentices affiliated with our apprenticeship program and has done so for more than
four years. We are registered with the United States Department of Labor, Bureau of
Apprenticeship and Training and our registration number is IN010520001. Our
program participates in the Building Trades Associate Degree Program with Ivy Tech
Community College and has done so since 1996. There have been over 300
apprentices in the last 5 years that have completed the apprenticeship and advanced to
Journeyman.
Gibson Lewis, LLC is a bona fide contractor in good standing with the
Indiana/Kentucky/Ohio Regional Council of Carpenters Joint Apprenticeship and
Training fund and is eligible to employ apprentice carpenters in the future. I have
enclosed a copy of our certificate from the United States Department of Labor.
If I can be of further assistance, please do not hesitate to give me a call.
Sincerely,
SWA
Chris Charters
Area Training Coordinator
IKORCCJATF — Merrillville, Lafayette & Warsaw Campuses
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INDIANA LAB ORERY TRAINING TR UST F UND
David A. Frye
Secretary -Treasurer
Jerry J. Bolk
Chris Brickey
Ricky Henson, Jr.
Ramon Mendoza, Jr.
Brian Short
P.O. Box 758 - Bedford, Indiana 47421
(812)279-9751
September 3, 2024
To Whom It May Concern:
C,
Sean Coakley, Director
John P. Brown
Chairman
Kelly Abel
Michael Ferrara
Stan Meyer
Nick Timmerman
Jim Wiseman
FAX: (812) 279-5545
Toll Free (800) 742-4086
This letter is to confirm that "Gibson -Lewis LLC is a signatory contractor in good standing with
the Indiana Laborers' Training Trust Fund.
The above mentioned company is a participant in the Joint Apprenticeship and Training
Committee through this Union and has been an active participant in good standing for each of the
past five plus consecutive years, and is currently eligible to use our apprentices on a project.
Further, our organization's program is approved by the U.S. Veterans Administration to
participate in the GI educational benefits program. A copy of our approval letters are attached
along with the collective bargaining agreement stating the ratios of Journey workers to
Apprentices; which is one (1) Apprentice for every five (5) Journey workers and thereafter may
not employ more that (1) Apprentice for every (3) Journey workers.
Sincerely,
Sean Coakley,
Director
SC:dc
www.indianalaborerstraining.org
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STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W-469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
The Indiana State Approving Agency conducted a supervisory visit on 01/8/2019 at Indiana
Laborers Training Trust Fund -Apprenticeship. The purpose of the visit was to provide training to
the Certifying Officials and review enrollment certifications, record retention and reporting
procedures.
The organization demonstrated proper record maintenance and record maintenance and reporting
procedures. During the visit, we discussed the importance of reporting hours on a monthly basis,
good record keeping techniques, and how to report a leave of absence or completion via VA Form
22-1999b. We also updated the Certifying Officials via VA Form 22-8794, work processes, and
wage scale.
If you need any assistance or have any questions regarding this technical visit please contact me
directly at tgriffm@dva.in.gov or (317) 232-3916. Thank you for the courtesy extended during my
visit. The education and training opportunities that your organization continues to provide veterans
and their dependents are appreciated.
Sincerely,
Taniqua Griffin
Program Director
011,004
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Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744
STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton Hill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
This will acknowledge receipt of your updated Wage Scale for the Construction Craft Laborer program
offered by Indiana Laborers Training Trust Fund -Apprenticeship. The State Approving Agency has reviewed
the document as listed below:
Wage Scale: Construction Craft Laborer
FACILITY CODE: 30004114
To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize erroneous
or misleading advertisement, either by actual statement, onussion, or intimation. It is understood by Indiana
Laborers Training Trust Fund -Apprenticeship that they will maintain a complete record of all advertising
utilized by or on behalf of the Indiana Laborers Training Trust Fund -Apprenticeship in regards to their
training programs during the preceding 12 months. Indiana Laborers Training Trust Fund -Apprenticeship's
advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S.
Department of Veteran Affairs.
Please Review the entire packet for content and accuracy. Approval is granted pursuant to the provisions of
Title 38, U.S. Code 3687, with an effective date of April 1, 2018.
If you have any questions, please feel free to give me a call at 317-232-3916 or email me at
tgriffin@dva.in.gov. Thank you for what you do for our Veterans, and have a great day!
Sincerely,
Taniqua Griffin
Program Director
State Approving Agency
Cc: VARO/ELR
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STATE OF INDIANA
DEPARTMENT OF VETERANS AFFAIRS
STATE APPROVING AGENCY
402 WEST WASHINGTON STREET ROOM W-469
INDIANAPOLIS, INDIANA 46204-2738
Jeremy Brewer
Apprenticeship Coordinator
Indiana Laborers Training Trust Fund -Apprenticeship
439 Patton ill Rd.
Bedford, IN 47421
Dear Jeremy Brewer,
Eric Holcomb, Governor
James M. Brown, Director
January 9, 2019
This will acknowledge receipt of your revised Work Processes for the Construction Craft
Laborer program offered at Hoosier Energy, located in Bedford, Indiana. The State Approving
Agency has reviewed the document as listed below:
TRAINING PROGRAM LENGTH DOT C0DI{:
Construction Craft Laborer
FACILITY CODE: 30004114
4,000-7800 hours 47-2061.00
To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize
erroneous or misleading advertisement, either by actual statement, omission, or intimation. It is
understood by Indiana Laborers Training Trust Fund -Apprenticeship that they will maintain a
complete record of all advertising utilized by or on behalf of the company in regards to their training
programs during the preceding 12 months. The company's advertising will be available for review
by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs.
This approval is made pursuant to and under the provisions of Title 38, U. S. Code 3687, with an
effective date of January 8, 2019.
If you have any questions, please contact me at 317-232-3916.
Sincerely,
Taniqua Griffin
Program Director
State Approving Agency
Cc: VARO/ELR
014
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Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/1/2019 And 12/31/2023
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2019
2020
Active
26
2.84 %
Adv. to Journeyman
96
10.47 %
Deceased
9
01980/0
Graduated
110
12.00 %
Inactive
11
1.20 %
Journeyman
12
1.31 %
Med. Susp,
1
0.11 %
Reinstate
2
0.22 %
Suspended
1
0.11 %
Terminated
578
63.03 %
Voluntary withdraw
71
7.74
Total Indentured 917
Active
32
4.95 %
Adv. to Journeyman
72
11.15 %
Deceased
2
0.31 %
Graduated
59
9.13 %
Journeyman
1
0.15 %
Not Registered
1
0.15 %
Reinstate
2
0.31 %
Suspended
1
0.15 %
Terminated
431
66.72 %
Voluntary withdraw
45
6.97
Total Indentured 646
Printed: a nes ay, May 29, 2024 Page T=3
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/1/2019 And 12/31/2023
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2021
2022
Active
%
13.07 %
Active Duty
1
0.13 %
Adv.-to Journeyman
68
9,07 %
Deceased
2
0.27 %
Graduated
65
&67 %
Reinstate
4
0.53 %
Suspended
2
0.27 %
Terminated
467
62.27 %
Voluntary withdraw
43
5.73 %
Total Indentured 750
Active
341
35.56 %
Adv. to Journeyman
70
7.30 %
Deceased
5
032 %o
Graduated
23
2.40 %
Journeyman
1
0.10 %
Med. Susp.
2
0.21 %
Not Registered
1
0.10 %
Reinstate
10
1.04 %
Suspended
9
0.94 %
Terminated
467
48.70 %
Voluntary withdraw
301
3.13
TotalIndentured 959
Printed: Wednesday, May 29.2024 Page 2 of 3
Apprentice Status Report By Indenture Date
Apprentices Indentured Between 1/l/2019 And 12/31/2023
Apprentice Program: IN2
Year Apprentice Status Apprentices Percentage
2023
1
0.10 %
Active
597
57.90 %
Active Duty
1
0.10 %
Adv. to Joumeyman
35
3.39 %
Deceased
2
0.19 %
Graduated
1
0.10 %
Journeyman
3
0.29
Med. Susp.
3
0.29 %
Not Registered
4
0.39 %
Reinstate
34
3.30 %
Suspended
4
.0.39 %
Terminated
325
31.52 %
Voluntary wiithdraw
21
2.04 %
Total Indentured 1031
Printed: Wednesday, May 29, 2024 Page 3 of 3
fwdNnitea tatrq Mrpartment f
If'a460t
Office of Apprentire-9bip
Certificate of Regi5tration of Apprentirr,5bip Program
FTI OF DC 91
Indianapolis, IN
See program standards for occupations
eyr'sfereo%as parf ol'112,c Va .16naj 3,oprenlrces-12rp 6 stern
in accorolance wilij fie basic siano(arors of-apprenlrce.s�-f
esfa� s erg fl:?-e 6ecrel= o� cr or
March 09, 2009 ��'�N' `1
)ale
IN070092065
Sri7�S 111�
4AV i •+L
7idmin�.+Iruiar, �J�rce o�f.�%pprrnircrs�ry
Plasterers' & Cement Masons'
Apprenticeship Coordinator Local Union #692
To Whom it May Concern:
Phone: (219) 707-7767
Email: bkristoff@plcmlocal692.org
September 5, 2024
This letter is to certify that Gibson -Lewis LLC. is and has been a signatory
contractor with OPCMIA Local 692 and has participated in the Plasterers &
Cement Masons Apprenticeship Training Program for many years. Gibson -Lewis
LLC. is a valued Contractor in good standing with Local 692 and the JATC. All our
apprentices are registered with the United States Department of Labor.
I may be reached at (219) 707-7767 if additional information is needed.
Further, our organization's program is approved by the U.S. Veterans
Administration to participate in the GI Education Benefit Program.
Thank you,
Brian Kristoff
Apprentice Coordinator
Plasterers & Cement Masons
9200 Louisiana Street a Merrillville, Indiana 46410
'anite% tatr.55 �e�artmerrt of �r�� r
0
office of Apprentirt5bip
(Certificate of 3&rgiaration of 2[pprtntirobip grogram
PLASTERERS & CEMENT MASONS LOCAL 692 J.A.T.C.
MERRILLVILLE) INDIANA
FOR THE TRADE CLASSIFICATIONS: CEMENT MASON; PLASTERER
JLepprsfereofds parf o� fie Q tonal f,nj�renflces�l�D c��Sfe122
J
In accoro(ance wlf12 h e 4aslc sfdno�zro(S Of Qpp renflces_.o
esfa4ft: ieo6� faze 6ecrefary o,f)-rodbor
MAY 22, 1995
Revised: November 1, 2018
I N010950002
4A 41
7r/irr'rrr'slrulor•. � ��%r�-e of `.�lppren/ic�>.�I�il+
GIBSON-LEWIS, LLC
CONTRACTORS
1001 West 11 th Street ♦ Mishawaka, IN 46544 ♦ P.O. Box 488 ♦ Mishawaka, IN 46546
(574) 259-8581 ♦ (574) 258-0932 FAX
www.gibson-lewis.com
Drug & Alcohol Free WorkPlace
The Company is committed to the establishment and maintenance of a safe and efficient
work environment for all employees free from the effects of alcohol, illegal drugs, and
other controlled substances and prohibited items.
Section 1. Polk
The Company is committed to providing its employees with a workplace that is safe,
productive and free of substance abuse. The company will take reasonable measures to
insure that employee alcohol or drug use does not jeopardize the safety of other
employees, does not impair their ability to operate efficiently and insures compliance
with drug testing programs mandated by state or federal agencies.
Section 2. Prohibitive Conduct — Drugs
The use, manufacture, distribution, dispensation, sale or possession of illegal drugs at any
time or place, whether on or off duty is strictly prohibited.
Legal Drugs — The use of legal drugs (over the counter or prescription medication) in
accordance with doctor's orders or manufacturer's recommendations, is not prohibited as
long as your Supervisor is notified. Excessive use beyond that prescribed or
recommended or abuse of such drugs, however, shall be considered use of illegal drugs
under this policy.
Section 3. Prohibitive Conduct — Alcohol
The unauthorized use or possession of alcoholic beverages while at the workplace or
performing company business, is prohibited. The term "work place" as used in this
policy includes company premises, jobsites, worksites, parking areas and company
vehicles.
The use of alcohol off premises in any manner which results in intoxication or
impairment on the job or which adversely affects attendance or job performance, is
prohibited.
Appearing for work or performing any -job duties or company business while intoxicated
or impaired by alcohol is strictly prohibited.
This may be an abbreviated version of the company's drug and alcohol free work place
policy. Check with your supervisor or person providing the new hire orientation for
further details.
A NATIONAL CONSTRUCTION ENTERPRISES COMPANY
- GIBSON -LEWIS LLC CONTRACTORS
1001 West 1 1" Street Mishawaka, IN 46544 P.O. Box 488 Mishawaka, IN 46546
't _�
(574) 259-8581 (574) 258-0932 FAX
To all lUPAT Members Gibson -Lewis Employees,
In order to meet the expectations of the General Contractors, Construction Managers, and
Building Owners, we at Gibson-Lcwis, LLC effective immediately, are implementing
that we will be following the BCRC (Building and Construction Resource Centers)
guidelines for drug testing. BCRC is an Alliance between the labor and the management
representatives for Local union # 460, and now # 1118. Their goal is to assist employers
with establishing and maintaining workplaces that are free from destructive effects
caused when employees use drugs and/or abuse alcohol.
What does this mean as a Gibson -Lewis Employee?
Each and every employee with in the union should have received a letter in January from
the BCRC (Building and Construction Resource Centers) along with a card and an I.D
number. This is your ID card for identifying yourself as the person who received it from
the BCRC. 1 will be attaching with this letter a copy of the letter sent to you back in
January, along with the phone number of how to contact the BCRC.
All Gibson -Lewis, LLC employees must have this drug testing procedure finalized by No
I..ater then, April 17th, 2009. If not completed by this time, employees will be unable to
come into work until the test has been completed.
Where can I take this drug test?
Any Med-Point clinic offers this drug test for the BCRC requirements. Check with
nearest Med-point clinic to set-up an appointment.
We at Gibson -Lewis, LLC want all of our employees to be safe everyday and be able to
work in a safe environment. Each day, our employees, along with you make a difference
to setting standards of being a safe company. By implementing this program, we are not
only taking this next step to being an elite company, we are taking a step towards an
injury free workplace.
Please contact me with any questions, at 574-780-3468.
Respectfully,
Brian Shumaker
Safety Director
�Y:\.: Y■N aA MA nY..N CYww
Building & Construction
Resource Center, Inc.
Phone: (219) 764-9500 • Fax: (219) 764-9505
TO Free: (877) 988-5400
6050 Southport Rd., Ste. B • Portage, IN 46368
www.BCRCNET.cojm
Tish Roach
Executive Director
'Perspectives
(800) 456-6327
www.perspectivesltd.com
Your Employee Assistance Program (EAP)
INDEX
PAGE
Introduction . . . . . . . . . . . . . . . . .
. 1
the Policy . . . . . . . . . . . . . . . . . .
. 2
Definitions . . . . . . . . . . . . . . . . . .
. 4
Drug Testing . . , . . . . . . . . . . . . , .
. 20
Drug Group . . . . . . . . .. . . . . . .
. 22
Alcohol Testing . . . . . . . . . . . . . . .
. 23
Payment for Testing . . . . . . . . . . . . .
. 24
Initial Testing (Pre -Employment) . . . . . .
. 27
Random Testing . . . . . . . . . . . . . . .
. 27
Vacation Status .... . . . . . . . ... ..
. 28
Owner Requested On -Site Random Testing.
.30
Probable Cause Testing . . . . . . . . . . .
. 31
Post-Accident/Incident Testing . . . . . . ,
. 32
Rapid Test Prohibited . . . . . . . . . . . .
. 34
"Emergency" Work Assignments . . . . . .
. 34
Card System . . . .. . . . . . . . . . . . .
. 36
Status Confirmation . . . . . . . . . . . . .
. 36
Reporting of Test Results . . . . . . . . . .
. 37
Insufficient Specimen
.38
Dilute Specimen . . . . . . . . . . . . . . .
. 38
Adulterated, Substituted, and/or
Out -of -Temperature Specimen . . . . . .
. 39
Consequences for a Non -Negative
or Positive Test . . . . . . . . . . . . . .
. 40
Additional Consequences for Multiple
Non -Compliant Events . . . . . . . . . .
. 42
INDIA
PACE
Observed Return To Duty Testing . . . . . .
. 44
Observed Follow -Up Testing . . . . . . . .
. 45
Disputed Positive Results . . . . . . . . . .
. 46
Appeals and Protections/just Cause . . . . .
. 47
Illinois — "Drug Free Workplace Act" —
30 ILLS 580 . . .. .. .... . . . . .
. 49
Illinois — "Substance Abuse Prevention on Public
Works Projects Act"— 820 ILCS 265 ....
50
Illinois — "Cannabis Regulation and Tax Act" —
410 ILCS 705 .... . . .. . . . . . . .
. 51
Indiana — Drug Testing for Public Works —
IND. Code 4-13-18 . . . . . . . . . . . .
. 51
Letters of Notice for Random Testing . . . .
.53
Attachment A — General Trades . . . . . . .
. 53
Attachment B — Non -Bargaining . . . . , .
. 54
Attachment C — Pipe Fitters Local #597 . .
.55
Attachment D — BCRC Authorization to Release
and Disclose Information & Documents . .
. 56
Attachment E — BCRC Application Form . .
. 59
— BCRC Permission Form to
Obtain BCRC Status .. ...
60
— BCRC Testing Information
and Instruction Sheet . . . .
. 61
Attachment F — BCRC On -Site Substance
Abuse Testing Addendum . .. . . . . .
. 62
Attachment G — BCRC Drug/Alcohol
Testing Notification . . . . . . . . . . . .
. 63
BUILDING AND CONSTRUCTION
RESOURCE CENTER, INC.
INTRODUCTION
The Labor and Management representatives of the Building
and Construction Industry for Northwest Indiana have formed
an alliance to address the problems caused by drug and alcohol
abuse. Management and Labor together have created the Building
and Construction Resource Center, Inc. (hereafter "BCRC"), an
independent not -for -profit corporation that offers a wide range
of services to Employees in the unionized construction industry,
which includes Employers and Labor Union organizations.
It is BCRC's goal to assist Employers in establishing and
maintaining workplaces that are free of the destructive effects
caused when Employees use or abuse drugs and/or alcohol.
BCRC's activities are not intended to interfere with normal
practices of the Labor Unions or Management. BCRC recognizes
its responsibility to communicate with and educate Employers
and Employees in the unionized construction industry concerning
this policy, as well as the harmful effects of drugs and alcohol in
our society and in the workplace. BCRC also recognizes the need
to provide a program of assistance to those persons for whom
drugs or alcohol may be causing problems. Our Employee
Assistance Program (EAP) provides support, counseling and
resources for life issues that can take a toll on your emotional
well-being or take time away from things you value the most,
like work and family. Finally, while not wishing to violate the
rights or invade the privacy of any Employee, BCRC's drug
testing program will seek to identify those Employees who are
unable or unwilling to conform to BCRC's program. This
program has been established in accordance with the Drug and
Alcohol Testing Industry Association (DATIA), the Substance
Abuse and Mental Health Services Administration (SAMHSA)
and the Federal Department of Transportation Guidelines for
specimen collection, laboratory analysis and review, and standards
of integrity and confidentiality.
1
THE POLICY
Persons who use or abuse drugs and/or alcohol, on or off their
jobs, are likely to be less productive, to be less reliable, to be more
frequently absent and to have other work -related problems that
can cause increased costs, delays, accidents and injuries.
These Employees can also risk the health, safety and well-being
of other workers on the job. The unionized construction industry
can control and reduce this problem through recognition of the
problem, development of a comprehensive policy and program of
education and information, promotion of an Employee Assistance
Program (EAP) and implementation of fair and respectful drug
testing that conforms to the Drug and Alcohol Testing Industry
Association (DATIA), the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the Federal Department
of Transportation Guidelines for specimen collection and analysis.
All of this is to be done with the utmost confidentiality and
respect for the individual.
All Employers (as defined herein) hereby adopt the following
policy:
No Employee may use, possess, distribute, deliver, or be under the
influence of a drug, or use or be under the influence of alcohol,
while performing any work for the Employer.
In order to enhance substance abuse awareness among all
Employers and Employees, educational seminars and training
programs will be offered. The educational seminars will be
directed toward education in regards to the seriousness of the
nationwide drug and alcohol abuse problem and how the use
of drugs and alcohol negatively impacts safety, productivity,
and the competitive ability of the American workforce.
Supervisors will be trained to identify Employees in potentially
difficult situations and to recognize signs of impairment, as well
as the Supervisors'responsibility to document, intervene and
follow-up with the troubled individual. These sessions will be
offered as ongoing training programs.
BCRC, encourages all Employees troubled by their own or a
family member's drug or alcohol abuse to seek professional care
and treatment. Early recognition and treatment of alcohol and
drug abuse provides the greatest opportunity for successful
recovery. BCRC provides an Employee Assistance Program
(EAP) for all Employees and their families who need professional
guidance in assessing their substance abuse or alcohol -related
problem and choosing an appropriate course of treatment.
Current Employees will be referred to an EAP Representative
as a result of a non -negative (positive) drug or alcohol test, a
non -compliant event or upon an individual's own request. In
either case, the content of the discussion with the EAP will be
protected and confidential to the extent allowed by law.
A Participant's use of and communications with the EAP are
confidential and information regarding such confidential matters
will not be released to BCRC or any of its subscribing
organizations or participants without written release from the
participant in accordance with the law. Employees who use the
EAP as a consequence of a non -negative (positive) drug or
alcohol test, or a non -compliant event, will be subject to the
conditions established in the drug testing portion of this policy
and as outlined by the EAP Counselor.
The EAP staff has knowledge of the level and types of benefits
available to BCRC Employees. Employees can access the services
of the EAP through a hotline that is staffed twenty-four (24)
hours a day, seven (7) days a week, throughout the entire year.
Employees calling the EAP hotline are put in touch with a
counselor who will conduct a professional assessment and who
may meet with them to further assess the nature of the problem
in order to provide a referral to the best and most appropriate
level of care. The EAP is staffed by certified and Masters -level
credentialed human services professionals who are sensitive to
3
the needs of the individual. Individuals who take the initiative
to contact the EAP for assistance do so with the assurance that
their calls will be treated respectfully and confidentially. The direct
services provided by the EAP are sponsored by BCRC.
In compliance with Public Law 100-690 (The Drug -Free Workplace
Act), which applies only to Employers who have federal grants
or federal contracts of more than $100,000, an Employee who
is convicted of a workplace drug or alcohol violation and who is
employed by a BCRC affiliated Employer must report this information
to his/her immediate supervisor no later than five (5) days after
such conviction. The Supervisor must report this information
immediately to the Employer's Program Administrator.
DEFINITIONS
■ Addendums (i.e., Attachment F) may be approved by
the Board of Directors on an as -needed basis.
Adulterated Specimen means a specimen that has been
altered, as evidenced by test results showing either a
substance that is not a normal constituent for that type
of specimen or showing an abnormal concentration of
an endogenous substance.
Air Blank means, in evidential breath testing devices
(EBTs) using gas chromatography technology, a reading
of the device's internal standard. In all other EBTs, a
reading of ambient air containing no alcohol.
• Alcohol means the intoxicating agent in beverage
alcohol, ethyl alcohol, or other low molecular weight
alcohols including methyl and isopropyl alcohol.
• Alcohol Concentration (or contents means the alcohol
in a volume of breath expressed in terms of grams of
alcohol per 210 liters of breath as indicated by an
evidential breath test under this policy (BrAC).
Alcohol Confirmation Test means a subsequent test
using an EBT, following a screening test with a result of
0.02 or greater, which provides quantitative data about
the alcohol concentration.
Alcohol Screening Device (ASD) a breath or saliva
device, other than an EBT, that is approved by the
National Highway Traffic Safety Administration
(NHTSA) and appears on the Office of Drug and
Alcohol Policy and Compliance (ODAPC) web page
for "Approved Screening Devices to Measure Alcohol
in Bodily Fluids" because it conforms to the model
specifications from NHTSA.
■ Alcohol Screening Test means an analytic procedure to
determine whether an employee may have a prohibited
concentration of alcohol in a breath specimen.
• Alcohol Testing Site a place selected by the Employer
where employees present themselves for the purpose of
providing breath or saliva for an alcohol test.
• Alcohol_Use means the drinking or swallowing of any
beverage, liquid mixture or preparation (including any
medication), containing alcohol.
■ Aliquot means a fractional part of a specimen used for
testing. It is taken as a sample representing the whole
specimen.
• Applicant means a person, Independent Contractor,
or Employer, or person working for an Independent
Contractor, or Employer who applies to become an
Employee of a BCRC Contractor/Employer Participant,
and includes a person who has received a job offer made
contingent on the person passing a drug test.
5
• Archived Status means the status of a person who has
been inactive, deactivated, working outside of the
geographic area covered by BCRC or otherwise taken
out of the BCRC. random pool.
• Authorized Test means a drug and/or alcohol test
performed in accordance with the provisions of this
Policy and at the request (or direction) of BCRC.
BCRC means Building and Construction Resource
Center, Inc., which is a not -for -profit corporation
formed by labor and management representatives of
the building and construction industry for Indiana &
Illinois, for the purpose of addressing problems of drugs
and alcohol in the workplace.
BCRC Policv means all of the policies, procedures, and
other matters set forth in this document (i.e., the BCRC
Drug & Alcohol Policy) and all amendments and
addenda to this document.
• Breath Alcohol Technician (BAT) is a person who
instructs and assists employees in the alcohol testing
process and operates an Evidential Breath Testing
device (EBT).
Canceled Test means a drug or alcohol test that has a
problem identified that cannot be or has not been
corrected. A canceled test is neither a positive nor a
negative test. An Employer is not permitted to take
adverse job action based on a canceled test.
Card Manager is the individual designated by each
Employer who has the authority to access data
information that will confirm the status of Employees
by electronic mail.
C01
• CL or Clear means that an Employee is "cleared",
available for work, and currently compliant with this
Policy when used with respect to the BCRC status of
an Employee.
Chain of Custody the procedure used to document the
handling of the urine specimen from the time the
employee gives the specimen to the collector until the
specimen is destroyed. this procedure uses the Federal
Drug Testing Custody and Control Form (CCF) as
approved by the Office of Management and Budget.
• Collection Container means a container into which
the Employee urinates to provide the specimen for a
drug test.
Collection Site means a place designated by BCRC
where individuals present themselves for the purpose of
providing a specimen to be analyzed for the presence of
controlled substances or for purposes of providing a
breath sample to be analyzed for alcohol concentration.
Collector means a person who instructs and assists
Employees at a collection site, who receives and makes
an initial inspection of the specimen provided by those
employees, and who initiates and completes necessary
forms.
Company means an Employer/Contractor who is a
member of BCRC.
• Confirmation (or confirmatory) DrµgTcst a second
analytical procedure performed on a different aliquot of
the original specimen to identify and quantify the
presence of a specific drug or drug metabolite.
7
• Canfirmationlnr_cynfumatory} ValidityTe, 5 a second
test performed on a different aliquot of the original
urine specimen to further support a validity test result.
• Confirmed DrugTests a confirmation test result
received by an MRO from a laboratory.
■ Confirmatory Test
a) For alcohol testing, a confirmatory test is a second
test following a screening test with a result of 0.02
or greater, conducted 15-30 minutes later, that
provides quantitative data of alcohol concentration.
this test is conducted on an Evidential Breath
Testing Device (EBT).
b) For controlled substances testing, a confirmatory
test is a second analytical procedure on the same
specimen to identify the quantitation and
presence of a specific drug or metabolite. This
confirmatory test is independent of the initial test
and uses a different technique and chemical
principle from that of the screening test in order
to ensure reliability and accuracy. Gas
Chromatography/Mass Spectrometry (GC/MS)
is the only authorized confirmation method for
cocaine, marijuana, synthetic opiates, opioids,
amphetamines and phencyclidine.
• Contractor Participant means an Employer who is a
contributing member of BCRC.
Controlled Substance means marijuana (THC),
cocaine, synthetic opiates, opioids, oxycodones,
MDA-analogues, phencyclidine (PCP), amphetamines
(including methamphetamines), methaqualone,
barbiturates, benzodiazepine, propoxyphene, methadone,
6-acetymorphine and ecstasy.
I)esignated Employer Representative (DER an
Employee authorized by the Employer to take immediate
action(s) to remove Employees from safety -sensitive duties
or cause Employees to be removed from these covered
duties and to make required decisions in the testing and
evaluation processes. The DER also receives test results
and other communications for the Employer consistent
with the requirements of this policy. Service agents
cannot act as DERs.
• Dilute Specimen means a specimen with creatinine
and specific gravity values that are not consistent with
medical expectations for human urine.
DOT these terms encompass all DOT agencies,
including, but not limited to, the Federal Aviation
Administration (FAA), the Federal Railroad
Administration (FRA), the Federal Motor Carrier
Safety Administration (FMCSA), the Federal Transit
Administration (FTA), the National Highway Traffic
Safety Administration (NHTSA), the Pipeline and
Hazardous Materials Safety Administration (PHMSA),
and the Office of the Secretary (OST). For purposes of
this part, the United States Coast Guard (USCG) in the
Department of Homeland Security is considered to be
a DOT agency for drug testing purposes only since the
USCG regulation does not incorporate Part 40 for its
alcohol testing program. these terms include any
designee of a DOT agency.
Drugs mean the substances for which tests are required
under this policy and include marijuana (THC), cocaine,
amphetamines (including methamphetamines),
methaqualone, phencyclidine (PCP), opioids, synthetic
opiates, oxycodones, MDA-analogues, barbiturates,
benzodiazepine, propoxyphene, methadone,
6-acetymorphine and ecstasy.
�61
DruVjest means a test conducted for controlled
substances.
• Employee means an Employee of a Company, or of a
Contractor/Employer Participant, who is a member
of BCRC.
Employee Assistance Pro am EAP Counselor
means a Masters -level professional with an education in
psychology, social work, counseling, etc. with knowledge
of and clinical experience in diagnosis and treatment
of alcohol and controlled substance related disorders.
the EAP will assess and make recommendations
concerning education, treatment, Observed Follow -Up
Testing and aftercare.
• Em-°lMr means a Company, or a Contractor/Employer
Participant, who is a member of BCRC.
Evidential Breath Testing Device EBT) means a
device approved by NHTSA for the evidential testing of
breath at the .02 and .04 alcohol concentrations, placed
on NHTSAs Conforming Products List (CPL) for
"Evidential Breath Measurement Devices" and identified
on the CPL as conforming with the model specifications
available from NHTSA's Traffic Safety Program.
First Occurrence. Clause means if an Employee does
not report for a random test, and it is the first time the
Employee has failed to report, the'Ihird Party
Administrator (TPA or BCRC) may allow the
Employee to take the test without reporting to the
EAP for further review. Employees may utilize this
clause only one time.
'Gas Chxomatography/Mass Spectrometry
Confirmation (GC/MS) is a state-of-the-art drug
testing technology, providing a fingerprint of the
detected drug.
10
HHS means the Department of Health and Human
Services or any designee of the Secretary, Department
of Health and Human Services.
HHS--AvoLoved Laboratory any US. laboratory
certified by HHS under the National Laboratory
Certification Program as meeting the minimum
standards of Subpart C of the HHS Mandatory
Guidelines for Federal Workplace Drug Testing
Programs; or, in the case of foreign laboratories, a
laboratory approved for participation by DOT under
this part.
Initial Test (for drugs) means an immunoassay screen
to eliminate negative urine specimens from further
consideration.
Initial 3 alidi Test means the first test used to
determine if a specimen is adulterated, diluted or
substituted.
Znrr id Dru Test the result reported by an HHS
certified laboratory in accordance with the criteria
established by HHS Mandatory Guidelines when a
positive, negative, adulterated or substituted result
cannot be established for a specific drug or specimen
validity test.
• Laboratory any U.S. laboratory certified by HHS
under the National Laboratory Certification Program as
meeting the minimum standards of Subpart C of the
HHS Mandatory Guidelines for Federal Workplace
Drug resting Programs; or, in the case of foreign
laboratories, a laboratory approved for participation by
DOT under this part.
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Licensed Medical Practitioner means a person who is
licensed, certified, and/or registered, in accordance with
applicable Federal, State, Local, or Foreign laws and
regulations to prescribe controlled substances and
other drugs.
Medical Review Officer (MRO) means a Licensed
Physician, registered with the American Association
of Medical Review Officers (www.aamroxom),
responsible for receiving laboratory results generated by
B CRC's drug testing program who has knowledge of
substance abuse disorders and who has appropriate
medical training to interpret and evaluate an
individual's confirmed positive test result together with
his/her medical history and any other relevant
biomedical information.
N/A or Not Available means that an Employee is not
available for work and is not currently compliant with
this Policy when used with respect to the BCRC status
of an Employee. (NOTE: An Employee can be N/A
for several reasons, which may or may not include failing
a drug or alcohol test).
New Employee/Applicant means a person who has not
been previously tested by BCRC and includes a person
referred for pre -employment testing.
Non -Compliant Event means any of the following:
(a) a Positive Test for alcohol or drugs (which shall also
include any Positive Tests that occur during any
retesting), (b) an -Insufficient Specimen if an appropriate
medical professional determines that there is no
legitimate medical reason for the Insufficient Specimen,
(c) a negative Dilute Specimen if the Employee fails
to provide a second (2nd) testing sample within the
applicable time period specified in this BCRC Policy
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or a second (2nd) testing sample that is also a negative
Dilute Specimen [provided, however, that a second (2nd)
negative Dilute Specimen shall not constitute a
Non -Compliant Event if. (1) the MRO determines
that there is a valid medical reason for the second (2nd)
Dilute Specimen, or (2) such treatment is prohibited by
applicable law], (d) an Adulterated Specimen, (e) a
Substituted Specimen, (f) an Out -of -Temperature
Specimen, (g) any acts by an Employee that compromise
the testing protocol (i.e., washes his/her hands, flushes
the toilet, etc.) prior to being given direction from the
collection professional, (h) a Refusal To Submit (to an
alcohol or controlled substances test), (i) a failure to
submit to Post-Accident/Incident Testing (which shall
include a failure to test resulting from the Employee
leaving the jobsite prior to such Post-Accident/Incident
Testing), and 0) any other act or omission by an
Employee that BCRC determines, in BCRC's sole
discretion, to constitute a substantial or willful
non-compliance with the policies and/or procedures set
forth in this Policy. A Non -Compliant Event is also
commonly referred to as a "strike."
• Non -Negative means a urine specimen that is reported
as an Adulterated Specimen, a Substituted Specimen, a
Positive Test [for drug(s) or drug metabolite(s)], a
Non -Compliant Event and/or invalid.
• Observed Follow-[]Uv T estinshall be required, based
on an EAP evaluation for a Non -Negative or Positive
Test result, missed random, incomplete test/walk outs
and as provided in this BCRC Policy. All Follow -Up
Testing will be administered by the TPA (BCRC) and
must be observed.
• Observed Return To Duty Test or Observed RTD Test
is an observed test required by this BCRC Policy that
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must be taken before an Employee can be returned to
"clear" status. Such test is scheduled by the counselor at
such time as the counselor deems appropriate after the
EAP evaluation has been completed. This BCRC Policy
requires such test following a Non -Negative test, missed
random, walkout, Refuse to Submit as described in the
BCRC Policy, or other Non -Compliant Event. If the
test is not taken as directed by the EAP, the Employee
will be required to return to the EAP.
• Out-of-Temi2crotureSpecirneii means a specimen
that is below 90°F or above 100°F at the time the
specimen is obtained at the collection site.
• Owner means a business or other entity (or individual)
that hires a "Contractor Participant" to perform work at
their facility, office, and/or property.
Owner Requested job -Site Random Testing means a
Northwest Indiana Business Roundtable Owner, which
has been approved by the Board of Directors, and may
require a random drug test be done at their facility.
The Employee will test within one hour of notification
of the random test. The test may be performed at the
Owner's facility no more than monthly provided there is
an approved BCRC Collection Site at the facility.
• Positive Test (alcohols occurs when an Employee's
confirmatory test result reads 0.02 BrAC or higher.
• Positive Test (dru) occurs when an HHS-certified
laboratory reports a drug test as positive because a
specimen contains a drug or drug metabolite equal to or
greater than the cutoff concentrations.
• Post-Accident/Incident Testing means drug and
alcohol tests requested by an Employer following the
occurrence of an accident and/or incident.
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_Probable Cause Testing maybe required when a
Supervisor observes and documents unusual behavior.
Program Administrator means the individual who has
administrative responsibilities for overseeing the drug
and alcohol testing program for an Employer.
the Program Administrator may serve as an
Employer's DER.
Pro a means all Employer -owned and/or leased
property, including but not limited to owned and/or
leased buildings and other real estate, parking lots and
vehicles located on parking lots, and Employer -owned
and/or leased vehicles, lockers, tools, equipment and
desks.
Random Selection means a scientifically valid method
for selection of Employees to be tested that result in an
equal probability that any Employee from a group of
Employees subject to the selection mechanism will be
selected, and does not give an Employer discretion to
waive the selection of any Employee under the
mechanism.
■ Refuse To Submit (to an alcohol or controlled
sUb tanC test
Means that an Employee:
1. Fails(ed) to appear for any test (except a
pre -employment test) within a reasonable time, as
determined by the BCRC Policy, after being directed
to do so by the BCRC Policy;
2. Fails(ed) to remain at the testing site until the testing
process is complete (a walk out);
15
3. Fails(ed) to provide a urine specimen for any drug
test required by this BCRC Policy;
4. In the case of a directly observed or monitored
collection in a drug test, fails to permit the
observation or monitoring of the Employee's
provision of a specimen;
5. Fails(ed) to provide a sufficient amount of urine
when directed, and it has been determined, through
a required medical evaluation, that there was no
acceptable medical explanation for the failure;
6. Fails(ed) or declines to take a second test the Employer
or collector has directed the Employee to take;
7. Fails(ed) to undergo a medical examination or
evaluation, as directed by the MRO as part of the
verification process, or as directed by the policy.
In the case of a pre -employment drug test, the
Employee is deemed to have refused to test on this
basis only if the pre -employment test is conducted
following a contingent offer of employment;
8. Fails(ed) to cooperate with any part of the testing
process (e.g., refuse to empty pockets when so
directed by the collector, behaves in a confrontational
way that disrupts the collection process, provides
incorrect or inaccurate information to the collection
site or on necessary forms, or fails to complete all
documents);
9. Provides a second (2nd) specimen that is dilute.
Reinstatement Testis the test allowed by BCRC, which
must be consistent with the Policy, to reactivate an
Employee who has been on "Vacation" or "Archived
16
Status" for twelve (12) months or more and has not
tested under the BCRC Policy in the past twelve (12)
months.
Rejected ForTesting the result reported by an
HAS -certified laboratory when no tests are performed
for a specimen because of a fatal flaw or a correctable
flaw that is not corrected.
Reporting Em to ee is an Employee who reports a
work -related injury or illness that was caused by and/
or relates to the accident and/or incident for which the
post-accident/incident drug or alcohol testing is
requested by the Employer.
Safe Site means a URL beginning with "https"which is
a secure site for data transmission.
SAMHSA means Substance Abuse and Metal Health
Services Administration is the agency within the U.S.
Department of Health and Human Services that leads
public health efforts to advance the behavioral health
of the nation.
Screening Test (oar initial test):
In drug testing, a test to eliminate "negative" urine
specimens from further analysis or to identify a
specimen that requires additional testing for the
presence of drugs.
In alcohol testing, an analytical procedure to determine
whether an employee may have a prohibited
concentration of alcohol in a breath specimen.
17
• S greening Test Technician (STT means a person who
instructs and assists employees in the alcohol testing
process and operates an Alcohol Screening Device
(ASD).
• Shipping Container means a container that is used for
transporting and protecting urine specimen bottles and
associated documents from the collection site to the
laboratory.
'Specimen means a sample of urine, used for analysis
and/or diagnosis. For the purpose of this policy;
specimen is defined as urine.
Specimen Bottle means the bottle that, after being
sealed and labeled according to the procedures in this
policy, is used to hold the urine specimen during
transportation to the laboratory.
• Split means a part of the urine specimen that
is sent to a first laboratory and retained unopened, and
which is transported to a second laboratory in the event
that the Employee requests that it be tested following a
verified positive test of the primary specimen or a
verified adulterated or substituted test result.
Substituted Specimen means a specimen with
creatinine and specific gravity values that are so
diminished that they are not consistent with human
urine.
• 7estixig Levels means levels at or above when a
specimen is determined to be positive, and below when
a specimen is determined to be negative.
Third 12—aM Administrator TPA means an entity that
provides or coordinates one or more drug and/or alcohol
testing services to Employers. A TPA typically provides
or coordinates the provision of a number of such services
and performs administrative tasks concerning the
operation of drug and alcohol testing programs for
Employers.'fhis term includes, but is not limited to,
groups of Employers who join together to administer,
as a single entity, the drug and alcohol testing programs
of its Employees (e.g., having a combined random
testing pool).
• Traveler means a craft person who: (a) is coming to
work in the geographic area covered by BCRC, and
(b) is a member of a local union whose jurisdiction is
outside of the geographic area covered by BCRC.
Unauthorized Test means a drug and/or alcohol test
that is: (a) not performed in accordance with the
provisions of this Policy, and/or (b) not performed at the
request (or direction) of BCRC. Such tests include
retests initiated by an Employer and/or an Employee
that are not performed at the request (or direction) of
BCRC.
• Union means a Labor Organization that represents
Employee(s) wlio are employed by a Company, or of a
Contractor/Employer participant, who is a member of
Building and Construction Resource Center, Inc.
Vacation Status means the status of an Employee who
is temporarily removed from the BCRC random pool
while on vacation or a non -work related absence.
• Verified Test means a drug test result or validity testing
result from a HUIS-certified laboratory that has
undergone review and final determination by the MRO.
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